Gino Kenny warns of stark failures in public oral healthcare

Thanks for your statement this morning. I think it paints a very, very stark picture in relation to oral healthcare in Ireland and it's only when you read the statement that you would say that our oral health system is in a state of justice and correct me if I'm wrong but our public oral healthcare system is in a state of justice. system was much in better shape 25 years ago than it is now and obviously that has a knock-on effect in relation to as you said in your statement in relation to socio-economical factors because I think you can tell and kind of gauge by people's oral health via their socio-economical circumstances and this is kind of very, very stark and what has happened obviously and this can be employed to all our health factors in our public health is there is a two-tier health system in oral healthcare and obviously people will lose out in relation to getting access to intervention at that particular time. So in relation to the school screening program where are we at that you know obviously there is this is I think a key factor in relation to proper intervention but obviously that's there's kind of there's a lag and in order to have a proper screening program that children can actually get you know proper intervention what do we need to put in place in the next say two to three years to actually catch up with that Yeah well I suppose oral health is probably the one health area or health condition or health part of the health service where there's a visible I mean it's literally visible the difference between somebody who can afford to see the dentist regularly and somebody who cannot I mean that's the remarkable thing about dentistry and secondly dentistry is probably singular in that prevention can resolve a lot of problems so that is why the school screening service is so important because first of all it means a dentist sees a dentist sees a child at a young age and prevents problems and secondly all the children regardless of their means or their background are seen on an equal basis so what needs to be done is more dentists need to be employed in the public service because the dentists in the public service are specially trained and they focus on seeing children all dentists obviously can see children but if you specialise then you're going to have probably a greater impact and you know there are difficulties in hiring dentists first and foremost permission has to be given to hire the dentist so for many years when dentists were retiring and when they were going on leave they weren't being replaced as a matter of policy that has been relaxed but unfortunately when the HSE goes to hire dentists it just simply can't attract them to work there and that reflects a number of things but apparently the stress of working in the service where you're constantly dealing with children requiring emergency treatment exacerbates the problem so you have fewer dentists and they are seeing children and they are seeing children in emergency pain relief scenarios rather than actually getting out and preventing problems and visiting the schools and heading off all of those difficult engagements so in short more dentists need to be hired how do you do that will you make the HSE a more attractive place to work and you know you and we've we've said to the HSE on countless occasions it isn't just about salary it is about the working environment it's about professional development but realistically you know if instead of getting out and preventing problems you're dealing with pain relief and emergency treatment for children it's a very different job to what most people signed up for yeah I would also make the point that while you know rightly most people will focus on children special care patients are also big losers here again where the HSE isn't allowed or cannot take on consultants in special care dentistry because the law doesn't recognize the specialty of special care dentistry where you know we have eminently qualified dentistry where you know we have eminently qualified dentists working in the UK who want to come back here the HSE can't offer them consultant positions because there's no such thing as a specialist division of the register so what that means the Minister for Health could at the stroke of a pen recognize additional specialties that would have a huge benefit in terms of pediatric dentists in terms of special care dentists in terms of all sorts of specialties which are recognized in the UK for example which are not recognized here so that makes it particularly difficult for the HSE to bring in specialists because by law there's no specialty in pediatric or special care dentistry and I presume because of costs and because of the kind of crisis in the kind of the dental treatment service scheme more evasive dental treatment is happening more more extractions more than ever because obviously the cost of root canals and all that is not covered by the metal card am I correct on that? Well root canal treatments can be covered by the scheme but I mean a lot of the more expensive treatments are not I suppose the biggest difficulty you know if you were to ask and I turn to my colleagues if you were asking a dentist what the single biggest difficulty they have is the fact that the medical card scheme there's unlimited funding for extractions but if you're talking about the key preventative treatments like fillings there's limits put on it It's constantly you're just constantly putting out fires the most basic way I can describe it that's what I mean I never get a chance the scheme never lets me cure my patient of disease chasing my tail the whole time because I'm we're faced with patients that come in that have extensive disease needs and so the scheme only allows us to do a certain amount each year so I have to decide what's the most important two fillings that I can do that this calendar year the patient may need 10 so I hope by next year I can do two more and two more and two more by the time five years has come to the end I've managed to do 10 we're back to the start and we start the cycle again and I'm constantly dampening down fires where I've had absolutely no ability and there's no funding and no structure in place for me to actually talk about prevention can't why can't I just sit there get that disease under control then spend the money on the conversation on lifestyle no I'm talking about children and adults that's what we're doing we're constantly putting out fires we never get to the end the system the medical card scheme never lets me get to the to me to get my patient disease free it just can't anymore so I'm constantly it's a vicious cycle so you wonder why dentists are leaving I'm telling you they are so it's frustration I must be I feel like I'm pushing uphill year after year after year and I'm still in it and I'm maybe I'm a foolish optimist but I wanted to get better because it has to be about the patient yeah yeah um yeah it's it's a very stark to say the least just my kind of final two minutes I want to ask a question about um people that go over to different jurisdictions to get cosmetic work and obviously there's you know we know a lot of people have gone over to Turkey different countries for extensive cosmetic work in relation to uh oral health care which would be probably one quarter of the price if they got that work in Ireland to a certain degree to a certain degree it's it's it's cost or less and obviously if people are kind of looking at costs and they can get that treatment in Hungary or Turkey they will if they can get it for half twice um they will go to different jurisdictions I just want to get your views in relation to those that have gone to other jurisdictions to get kind of very vital work in relation to oral health care and there's obviously a kind of downside to that as well I just have yeah in relation to things that can go wrong and obviously if somebody presents themselves to a nurse a dentist and they've got that work if works have gone wrong I'm sure the dentist says look at well look at I didn't make that I didn't you know make that kind of uh mistakes and whatever and so forth just want to get your views in relation to all that kind of I suppose that I suppose narrative at the moment that you know people had to go outside the jurisdiction to get um oral health care and it's okay I'll ask my colleague Dr Reimer thank you deputy so um I suppose the the most stark statistic I can give you regarding medical tourism and dental dental tourism is that since 2019 nine Irish um people have have died while receiving medical care abroad since 2019 uh two cases um specifically regarding dentistry um we've no real reliable data on the number of patients looking for treatment abroad and this used to be primarily an economic decision uh for patients but increasingly as we were discussing it's becoming an issue of access so so if I have a patient uh who comes into me and they require maybe two or three crowns I can they can go onto a waiting list for a couple of months we may not have the ability to get them in that's quite a big piece of dental work so if I type into google or facebook dental crown what I'm going to be bombarded with is a series of ads coming from um you know eastern europe other areas uh abroad offering the discount rates for dental treatment uh often for huge courses of treatment so they're usually offered uh 16 crowns for x thousand euros which would be significantly cheaper than Irish prices of course what we're usually recommending to patients is minimally invasive dentistry so so we're counseling patients for the majority of the day about cutting the tooth as little as possible we want to preserve tooth structure we want to every time we intervene we're potentially reducing the life expectancy of the tooth and then creating them more problems further down the line so this patient's gone away with a recommendation of a treatment plan from me and they come back for their routine checkup and I can see them they've had a either two or three implants and 16 crowns on top of them uh or they've had the uh you know teeth which I would have regarded as being healthy have been removed and replaced with with implants or bridges these are often um hugely aggressive uh treatments which are very difficult for them to maintain so they can't maintain adequate hygiene so they're starting to collapse after a series after a number of years um often initially they're very happy with treatments and the offer that they've received online is that they get to combine this knockdown uh price with a holiday in the sun so it's very tempting to patients um but unfortunately we're dealing with the consequences and um they can be devastated that the patient oftentimes they've gone from a maybe a reasonable standard of dental health to a very poor standard of health and that particularly we talk of your Romanian dentistry Turkish dentistry of a very high standard but the problem I would have is with uh commercial enterprises aggressively advertising in Irish domain through uh advertising on online but also we would have had a month ago we had a series of uh interviews on radio and in press where we highlighted this issue combined with our colleagues in medicines in terms of bariatric surgery for you know treatments for obesity um we're seeing increasing numbers of people traveling abroad the following week in these print organizations you see advertorial articles advertising the very problem that we're trying to highlight so so we have a huge problem with um tourism and these vulnerable patients are being lulled into uh these attractive offers and unfortunately there is a lag between them getting the work and they're actually presenting with the problems so you might you know three or four years before things start to go awry but if you have had a piece of dental equipment welded into your mouth which you then can't clean it's going to disintegrate and it's just a case of how long yeah okay thanks very much i suppose it's also an impact on the you know the healthy seats if you have a crown or an implant there in relation if it's not placed you know that's it's the other challenge you i presume dentists say to me that they they're they're they're facing all the time that they're you know there's people and i don't put crack teeth from uh the case that always jumps out to me um it was a number of years ago now but i i saw a gentleman in his 30s who did have quite a severe um gun problem um but with the right intervention and seeing the right specialists i say again we have a problem recognizing specialists in this country if you see the right specialists they could have preserved their dentition their bite for many years um unfortunately he was tempted to receive treatment abroad and he had a mouth of a combination of crowns and bridges anchored to poor quality teeth and implants and within a couple of years unfortunately i had fit him with complete dentures uh in his 30s and that that's that does that does happen from time to time you do have patients present with those kind of problems but for him that situation was um grossly exacerbated by the treatment that he received and he certainly ended up in a much worse situation as a result of traveling abroad dentistry abroad there's absolutely no issue with quality of of dentistry in some areas but it's those commercial enterprises that are luring people abroad there's often very little in the way of a comeback with those clinics um we i would argue very strongly that patients need to look into the credentials of the clinic and the dentist that they're dealing with and and make sure that there's a recourse for them to um have problems resolved have dental problems occur as a result of any dental work you know so we always have to be uh cognizant that um things can go wrong and we would be aware of trying to help patients through that but yeah dental tourism is a huge problem for us no that i know sorry you know the nine people you said that have died that wasn't to do with or like cosmetics but it does generally cosmetic surgeries that is combat is combination of medical tourism but dentistry does is it does fall into that we have unfortunately had cases of of um and i was to say that a month ago when we were um asked to comment on this issue unfortunately it was the sad passing of a gentleman who had been abroad to seek treatment okay thanks